• Early screening of gestational diabetes, especially in high-risk pregnant women, should be used to detect early gestational diabetes and reduces morbidity for bot[r]
(1)(2)INTRODUCTION
GDM is rapid rising worldwide, especially in the Asia region
The prevalence of GDM varies from 8,9 – 53,4%:
New criteria by the IADPSG on diagnosis of GDM
Increment in the prevalence of obesity and T2DM in young women
(3)INTRODUCTION
The HAPO study showed a positive correlation between maternal hyperglycemia level and adverse maternal, fetal, and/or neonatal outcomes
Higher levels of maternal glucose with no defined levels, after which the risk increases
(4)INTRODUCTION
The IADPSG proposed the following definition for overt diabetes during pregnancy (ODM): pregnant women who meet the criteria for diabetes in the nonpregnant state but were not previously diagnosed with diabetes
Women with ODMP are newly defined as having:
Fasting glucose ≥ 7,0 mmol/l
or 2h post OGTT glucose ≥ 11,1 mmol/l
(5)INTRODUCTION
• Thus, types of glucose intolerance are identified in pregnancy: GDM and ODM
• Our hypothesis is that ODM would have a more severe glycemic disturbance and increased risk of both maternal and neonatal complications
• However, little has been reported regarding differences in pregnancy outcomes between these groups
(6)Patients and methods
• Patients and methods: The study conducted from 11/2014 to 7/2015 in Endocrinology - Bach Mai Hospital Data were collected on 283 women in the study including 104 with overt diabetes and 179 women with gestational diabetes These women were examined, managed blood glucose by modifying lifestyles and dietor insulin treatment until the end of pregnancy
(7)Patients and methods
Choose group for study:
GDM: (ADA 2011) 75 g OGTT at 24–28 weeks gestation
Fasting glucose: ≥ 5,1 mmol/l
1h post OGTT glucose: ≥ 10,0 mmol/l
2h post OGTT glucose: ≥ 8,5 mmol/l
ODM: (ADA 2011)
Fasting glucose ≥ 7,0 mmol/l
(8)Patients and methods
We excluded from the study:
Women with multiple fetal gestations, pre-gestational diabetes, history of previous treatment for gestational
diabetes, active chronic systemic disease other than
chronic hypertension, women with the second of
(9)Patients and methods
Question:
Age (yrs)
BMI before pregnancy (kg/m2)
Gestational weight gain (kg)
Gestational age at diagnosis (wk)
(10)Patients and methods
Exam:
Blood pressure:
BMI
Sub – clinical:
75 g OGTT at 24–28 weeks gestation
HbA1C
(11)Patients and methods
TREATMENT:
Insulin therapy
Max insulin dose
Treatment goals (ADA 2011)
Fasting glucose : ≤ 5,3 mmol/l
(12)Patients and methods
Adverse pregnancy outcomes: • Polyhydramnios
• Preterm birth • Hypertension
(13)Patients and methods
Adverse pregnancy outcomes • Large-for-gestational age • Small-for-gestational age • Hypoglycemia
• Apgar
(14)ODM ( n = 104)
GDM ( n = 179)
p
Age (y) 31.5 ± 4.3 30.3 ± 5.8 p > 0.05
BMI (kg/m2) 22.6 ± 3.2 20.8 ± 5.8 p < 0,05
Baseline characteristics
Tuổi: Wong, Sugiyama không khác biệt Sumin có khác biệt BMI: Khác biệt Wong, Sugiyama, Sumin
(15)Results and discussion
ODM n = 104
GDM n = 179
p
Gestational age at diagnosis (wk) 27.4 ± 6.4 26.1 ± 1.9 p > 0.05 Gestational weight gain (kg) 10.1 ± 4.6 11.2 ± 3.5 p > 0.05
(16)Results and discussion
ODM
n = 104
GDM
n = 179 p
Yes – n (%) 76 (73,1 %) 50 (27,9 %) p < 0.01
No – n (%) 28 (26,9 %) 129 (72,1 %)
(17)0 10 15 20 25 30 35 40
Family history of diabetes
BMI ≥ 23 A history of delivering big
baby
Glucosuria Past history of GDM
Glucose tolerance disorder
40
34
21 20
10
6 14
24
8
2
1
ODM GDM
p < 0.01
Số thai phụ
Results and discussion
(18)Results and discussion
Đặc điểm ODM
n = 104
GDM n = 179
p Antenatal oral glucose tolerance
test (fasting result) (mmol/l) 7.4 ± 2.6 5.1 ± 0.4 p< 0.001 Antenatal oral glucose tolerance
test (2-h result) (mmol/l) 13.4 ± 2.1 9.2 ± 2.8 p< 0.001 HbA1C (%) 6,6 ± 1,2 5.2 ± 0.3 p< 0.01
Ceton urinary 18(17.3%)
(19)Results and discussion 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
ODM GDM
77.9%
6.7% 22.1%
93.3%
Insulin therapy
Insulin therapy – no
Insulin therapy
(20)Results and discussion
ODM
n = 104
GDM
n = 179 p RR
Reach treatment goals n = 231
76 73.1 %
155 86.6 %
p < 0.01
2.4 (1.3 – 4.4) No reach treatment goals
n = 52
28 26.9 %
24 13.4 %
(21)Results and discussion
ODM
n = 86
GDM
n = 179 p
Gestational age at delivery (wk) 38.2 ± 1.6 39.0 ± 1.3 p < 0.01
Birth weight (g) 3.3 ± 0.6 3.2 ± 0.5 p > 0.05 Cesarean section – n (%) 66 (76.7%) 114 (80.4%) p > 0.05
(22)ODM n = 86
GDM n = 179
p RR
95% CI
Yes - n 51 58 < 0.001 1.8
(1.4 – 2.4)
% 59.3% 32.4%
Adverse pregnancy outcomes
(23)ODM n = 86
GDM n = 179
p
RR 95% CI
Polyhydramnios 19 (22.1) 23( 12.8) > 0.05 1.7 (0.9 – 2.8)
Preterm birth 22 ( 25.6) 18 (10.1) < 0.01 2.5 (1.4 – 4.5) Hypertension – n (%) 11 ( 12.8) 5 ( 2.8) < 0.01 4.6 (1.6 – 12.7)
Pre-eclampsia and Eclampsia
6 (7.0) (0.6) < 0.05 -
Stillbirth 1(1.2) 1(0.6) - -
Maternal complications
Results and discussion
(24)ODM n = 86
GDM
n = 179 p
RR 95% CI
LGA – n (%)* 10 (11.6) 10(5.6) p > 0.05 2.1 (0.9 – 4.8) SGA – n (%)** (10.5) 10 (5.6) p > 0.05 1.9 (0.8 - 4.4)
Hypoglycemia – n (%) 5 (5.8) 2 ( 1.1) p < 0.05 5.2 (1.0 - 25.2)
Congenital
malformations – n (%)
4 (4.7) (0.6) p > 0.05 -
Neonatal death 1(1.2) - - RDS – n (%)*** 1(1.2) - -
Neonatal complications
Sugiyama khơng khác biệt tỉ lệ HĐHSS Wong có khác biệt tỉ lệ HĐHSS
Results and discussion
(25)Conclusions
• Most of the women in the groups overt diabetes have high risk factors (73,1%)
• GDM just control blood glucose with diet (93.3%) 77.9% of ODM group need insulin to control blood glucose
• ODM have rate of complications for mother and fetus is higher than GDM (59.3% versus 32.45%, p <0.01)
(26)Recommendation
(27)